Rory Fisher, MB, FRCP(Ed)(C), Professor Emeritus, Department of Medicine, University of Toronto and The Regional Geriatric Program of Toronto, Toronto, ON.

Euthanasia and assisted suicide are attracting increasing public interest. The experiences in the Netherlands and Oregon are explored as well as the topics of terminal sedation and voluntary dehydration. The reasons for requests for euthanasia are broadening beyond medical issues. Reasons for and against are presented. Recommendations are made to improve care of the dying and the frail elderly to decrease the perceived need for euthanasia. If changes are made to legalize euthanasia and/or assisted suicide in Canada, there will be a need to protect conscientious objectors.
Key words: euthanasia, physician-assisted suicide, terminal sedation, end-of-life care, conscientious objectors.

Dr. Michael J. Taylor

The following article attempts to add insight into the complex and difficult issue of physician assisted suicide by approaching it from a broad perspective. The article will begin with a brief and informal historical survey of attitudes toward physician assisted suicide. It will then address the arguments both for and against this issue, and conclude with an examination of some of the evidence that is available to support concerns of those on both sides of the debate. Included in the article are some inferences as to the direction debates about physician assisted suicide might take in the future. Though terms such as euthanasia and physician assisted suicide are often used to denote different entities both by the lay public and within the medical literature, for the purposes of this article, the term physician assisted suicide is used to describe the active involvement of a physician in ending the life of a patient at the patients specific request (i.e. through the prescription or administration of lethal medications). The act of ending the life of a patient without his or her specific request (i.e. "mercy killing"), and the decision to forgo life sustaining treatment (including the use of ventilators, dialysis or feeding tubes) are not included within the definition of physician assisted suicide as discussed in this article.